Kang Sungwook, You Chang Hoon, Kwon Young Dae, Oh Eun-Hwan
Department of Public Health, Daegu Haany University, Gyeongsan, Gyeongbuk, Korea.
J Formos Med Assoc. 2009 Dec;108(12):912-20. doi: 10.1016/S0929-6646(10)60003-4.
BACKGROUND/PURPOSE: The coverage of social health insurance has remained limited, despite it being compulsory in Korea. Accordingly, Koreans have come to rely upon supplementary private health insurance (PHI) to cover their medical costs. We examined the effects of supplementary PHI on physician visits in Korea.
This study used individual data from 11,043 respondents who participated in the Korean Labor and Income Panel Survey in 2001. We conducted a single probit model to identify the relationship between PHI and physician visits, with adjustment for the following covariates: demographic characteristics, socioeconomic status, health status, and health-related behavior. Finally, we performed a bivariate probit model to examine the true effect of PHI on physician visits, with adjustment for the above covariates plus unobservable covariates that might affect not only physician visit, but also the purchase of PHI.
We found that about 38% of all respondents had one or more private health plans. Forty-five percent of all respondents visited one or more physicians, and 49% of those who were privately insured had physician visits compared with 42% of the uninsured. The single probit model showed that those with PHI were about 14 percentage points more likely to visit physicians than those who do not have PHI. However, this distinction disappears in the bivariate probit model. This result might have been a consequence of the nature of private health plans in Korea. Private insurance companies pay a fixed amount directly to their enrollees in case of illness/injury, and the individuals are responsible subsequently for purchasing their own healthcare services.
This study demonstrated the potential of Korean PHI to address the problem of moral hazard. These results serve as a reference for policy makers when considering how to finance healthcare services, as well as to contain healthcare expenditure.
背景/目的:在韩国,尽管社会医疗保险是强制性的,但其覆盖范围仍然有限。因此,韩国人开始依赖补充性私人医疗保险(PHI)来支付医疗费用。我们研究了补充性PHI对韩国人就医的影响。
本研究使用了2001年参与韩国劳动与收入面板调查的11,043名受访者的个人数据。我们进行了单因素概率模型分析,以确定PHI与就医之间的关系,并对以下协变量进行了调整:人口统计学特征、社会经济地位、健康状况和与健康相关的行为。最后,我们进行了双因素概率模型分析,以检验PHI对就医的真实影响,并对上述协变量以及可能不仅影响就医,还影响PHI购买的不可观测协变量进行了调整。
我们发现,约38%的受访者拥有一项或多项私人健康保险计划。45%的受访者看过一位或多位医生,在有私人保险的受访者中,49%的人看过医生,而未参保者的这一比例为42%。单因素概率模型显示,拥有PHI的人就医的可能性比没有PHI的人高出约14个百分点。然而,在双因素概率模型中,这种差异消失了。这一结果可能是韩国私人健康保险计划性质的结果。私人保险公司在参保人患病/受伤时直接支付固定金额,随后由个人负责购买自己的医疗服务。
本研究证明了韩国PHI在解决道德风险问题方面的潜力。这些结果为政策制定者在考虑如何为医疗服务融资以及控制医疗支出时提供了参考。